An Ounce of Health Prevention or Ten Pounds of Cure

As the time nears when the US government will unveil its long anticipated bill for reforming the US health care system, we are all reminded just how important and how costly health care can be at both a personal and national level. With estimates for the cost of health care reform pegged at around $1 trillion dollars over ten years, a lot of money is being thrown at the problem of making health care better and hopefully more affordable to individuals and the country at large.

Though these efforts have the potential to pay off if the US can eventually attain the relative efficiencies of other first world countries, one aspect of health care reform that is often poorly addressed is prevention. Though the reform bill has elements to address the need for disease prevention, prevention is one of the most untapped ways of limiting health care costs.

In failing to take advantage of this opportunity, the US is not alone. Countries like the UK, Canada, Australia and New Zealand, to name a few, all face avoidable costs within their health systems that could be addressed with prevention. Smoking, obesity, excess alcohol consumption, and lack of physical fitness all contribute to unnecessary health costs. Also adding to the preventable costs is the lack of regular checkups to allow earlier detection of conditions. Many conditions are much easier to treat when detected early, but they cannot be found if we do not visit the doctor to have tests run.

In many countries, health promotion campaigns encourage people to exercise, to stop smoking, to control alcohol intake and to lose weight, but generally, little incentive is provided for individuals to do so. If countries are serious in reducing their health care spending from approximately 10% of their GDP (the US spends 16-17%), a much stronger incentive program is required.

While it is all good and well to rely on the virtues of people to do the right thing, life creeps in and disturbs the most well-intentioned New Year's resolution or advice from our doctors. To provide that added "inspiration", our collective lack of sustained will must be addressed through monetary incentive. Psychology researchers at London's Kings College have determined that such incentives can work at some level so it is worth looking at this approach as an alternative to simply using prevention techniques that tell us about the benefits that we might receive.

What is needed is a system of tax credits and immediate rewards that promote behaviors reducing health care costs. These incentives could be provided to those who don't smoke. They could likewise be provided to those involved in a doctor-registered exercise plan. For those who struggle with obesity, the incentives could also be provided to those enrolled and active in weight management programs. They could also be provided to people to ensure they take their medication on schedule. Lastly, they could be provided to those who get annual or six-month checkups just to provide that extra kick to visit the doctor on a regular basis.

The reason why both tax credits and immediate rewards would be combined is that different people will be motivated toward more short or long-term rewards and an effective program must target both groups.

In most countries, alcohol and cigarettes are taxed significantly and yet consumers continue to pay these taxes and continue their habits. A portion of these taxes needs to be directed toward such incentive-based prevention programs. Although a related fat tax could also provide some revenue, the relation of sugary drinks to overall health is a little less clear and taxation in this area is more open to resistance by the large companies selling the products. Fat tax aside, if these programs are effective, any additional costs resulting from these programs would be overshadowed by the reductions in overall health care costs.

Should the incentive programs be put in place, they also have the potential to reduce the number of physicians required. Nurses could handle many of the efforts involved in prevention and a healthier population would require fewer physicians. This would result in further cost savings while helping to address the shortage of physicians faced in most countries.

Though the US is struggling to obtain health reform at one level, there is a whole next level of health reform that can reduce costs further. If we are truly interested in reducing the costs of health care and improving the population's overall health, active prevention programs are required and subsidizing people with their own tax dollars is a feasible incentive. Governments are familiar with such approaches and use them all the time. This is simply another use of a successful well-used formula.

What do you think of health subsidies in general? Do you agree with the psychology? Do you think that they can reduce costs overall?

I have read studies showing that in developed countries, the lack of neighborhood recreational space that includes the natural environment leads to higher levels of obesity; therefore, lower overall well being. People living in the inner city are surrounded by fast food and have nothing to do. This is going to make them get fat.

Achieving health and maintaining healthy is an ongoing process. Effective strategies for staying healthy and improving one's health requires motivating people. It is way cheaper to give them small gifts than pay for a quadruple bypass. Since the insurance companies are going good, they can hand out motivation rewards and then make more money.